Abstract

Background All the published Saving Mothers Reports generated by the National Committee of the Confidential Enquiries into Maternal Deaths in South Africa have associated anaesthesia-related maternal deaths with the lack of skills of the doctors administering the anaesthesia. The Reports have shown the Free State to be one of the provinces in South Africa with the highest rate of obstetric anaesthesia deaths. Therefore, the current study was performed to determine whether a deficiency exists in the training and experience of doctors administering obstetric anaesthesia. The identifying of such a deficiency would call for the implementation of remedial measures.

Methods The study was performed in 2005 using questionnaires designed by the first two authors of this paper. All Level 1 and 2 hospitals in the Free State performing Caesarean sections (CSs) were visited. The doctors administering obstetric anaesthesiawere each asked to respond to a questionnaire. The questionnaires enquired about previous training and experience in anaesthesia and, more specifically, obstetric anaesthesia, as well as anaesthesia and nonanaesthesia qualifications. In addition, questions were asked regarding supervision, and whether other duties were performed while administering anaesthesia.
Results The response rate was 69% (105/148 doctors). Of the respondents, 9.5% were interns, 24.7% community service doctors, 47.6% medical officers, 15.2% general practitioners (GPs) and 2.9% specialists. Twenty-three per cent of respondents had been in their present post for five years or more. Most doctors had received 4 weeks or less training in anaesthesia as an Intern, not including obstetric anaesthesia in 13 cases. Six doctors (GPs or medical officers) had been appointed in posts in which obstetric anaesthesia was required, without previously having administered obstetric anaesthesia. At the time of the survey, two doctors had never performed spinal anaesthesia and five had never administered general anaesthesia for CS, although all were regularly administering obstetric anaesthesia. Apart from the specialists, the Diploma in Anaesthesia was held by only one doctor, a medical officer. Half of the interns were not directly supervised while administering obstetric anaesthesia, while more than half the community service doctors were employed in hospitals where no senior support was available. The doctors frequently had both to administer the anaesthetic and to perform neonatal resuscitation. Twelve of the doctors concerned had often also to perform the surgery itself. Most of the doctors requested further training in obstetric anaesthesia and improved senior anaesthetic assistance.
Conclusions There is a lack of experience, training and supervision amongst doctors administering obstetric anaesthesia in the Free State. Doctors regularly have to perform other duties, whilst administering obstetric anaesthesia, which may put the mother at risk from inadequate observation. These may be contributory factors to the high rate of maternal deaths from anaesthesia.